Abstract

Background

Individual barriers to weight loss and physical activity goals in the Diabetes Prevention
Program, a randomized trial with 3.2 years average treatment duration, have not been
previously reported. Evaluating barriers and the lifestyle coaching approaches used
to improve adherence in a large, diverse participant cohort can inform dissemination
efforts.

Results

Top weight loss barriers reported were problems with self-monitoring (58%); social
cues (58%); holidays (54%); low activity (48%); and internal cues (thought/mood) (44%).
Top activity barriers were holidays (51%); time management (50%); internal cues (30%);
illness (29%), and motivation (26%). The percentage of the cohort having any type
of barrier increased over the long-term intervention period. A majority of the weight
loss barriers were significantly associated with younger age, greater obesity, and
non-Caucasian race/ethnicity (p-values vary). Physical activity barriers, particularly
thought and mood cues, social cues and time management, physical injury or illness
and access/weather, were most significantly associated with being female and obese
(p < 0.001 for all). Lifestyle coaches used problem-solving with most participants
(≥75% short-term; > 90% long term) and regularly reviewed self-monitoring skills.
More costly approaches were used infrequently during the first 16 sessions (≤10%)
but increased over 3.2 years.

Conclusion

Behavioral problem solving approaches have short and long term dissemination potential
for many kinds of participant barriers. Given minimal resources, increased attention
to training lifestyle coaches in the consistent use of these approaches appears warranted.